Special Populations

Certain populations face additional barriers to accessing health coverage. A health disparity is a specific kind of health difference often linked with social, economic, and/or environmental disadvantage. Health disparities have an adverse impact on people who have historically experienced barriers to health care related to discrimination and exclusion. Consumer Health Coalition makes it our mission to assist these community members and work to close health disparities.

Refugees and Immigrants

Immigrants, even those who have become naturalized U.S. Citizens, have historically faced barriers to accessing health care that can be impacted by socio-economic issues, environmental hazards, and language barriers.

Compared with immigrants who have become citizens, non-citizen immigrants are less likely to be enrolled in health insurance, even though a majority are eligible for financial assistance on the Affordable Care Act Marketplace.

In Pennsylvania, adult non-citizen immigrants are not eligible for Medicaid until they have held permanent resident status with Green Cards for at least five years. However, this five-year bar is waived for children and pregnant women. Lawfully present children can enroll in either Medicaid or CHIP, based on income eligibility.

Immigrant adults who are not eligible for Medicaid have the option to purchase Marketplace health coverage that may include large subsidies to make it affordable, depending on household income.

These rules can be difficult to navigate, which is why our Health Care Navigators have relationships with many organizations that serve immigrants and refugees to ensure individuals and families can find the health coverage that meets their particular circumstance and need.

Refugees face additional barriers to health care. An average of 70,000 refugees arrive in the U.S. each year, coming from all over the world. Refugees who have fled war torn areas may face health issues from hunger and malnutrition, experiencing violence, trauma, or complications from untreated chronic conditions. The process of moving to the U.S. and adapting to a new lifestyle puts immigrants at risk for additional health conditions.

LGTBQ

56% of lesbian, gay, or bisexual patients have experienced discrimination in a healthcare setting, according to a study by Lambda Legal. The number was even higher–70%–for transgender or gender-nonconforming patients.

The Affordable Care Act has benefited the LGBTQ community in a number of ways, which include prohibiting sex-based discrimination and lowering the uninsured rate among people who are LGBTQ.

People who identify as LGBTQ are at risk for health disparities influenced by societal stigma. Research shows that stigma and discrimination faced by this population has been linked with higher rates of mental health conditions, substance abuse, and suicide.

Section 1557 of the ACA prohibits sex-based discrimination, including on the basis of gender identity or sex stereotyping, in any health program or activity that receives federal funds. This protection includes insurance plans sold on the Health Insurance Marketplace and state Medicaid agencies.

It is crucial to work toward eliminating the health disparities for people who are LGBTQ to insure that individuals can access culturally competent and comprehensive health care.

For resources on finding an LGBTQ-friendly provider, visit the Human Rights Campaign website For LGBTQ Patients.

Racial and Ethnic Disparities

Health disparities remain a large problem in the United States. People of color face significant disparities in accessing and using health care. They are more likely to be uninsured, receive poorer quality of care, and experience worse outcomes in their health relative to white people.

People who are Hispanic, Black, American Indian, and Alaska Native have greater barriers to health care, tend to use health care less, and tend to have worse health outcomes than people who are white. People with low incomes are also more likely to have poorer access to health care and poorer health outcomes than people who are wealthy.

The Affordable Care Act (ACA) contributed to a sharp decrease in uninsured rates among people who are Hispanic and Black. In addition to making health insurance more accessible, the ACA includes efforts aimed specifically at disparity. The ACA created Offices of Minority Health within the Department of Health and Human Services to coordinate efforts to reduce disparity. It strengthened data collection about health disparity and included public health initiatives that emphasize racial and ethnic disparities. However, wide health disparities still remain.

People Who are Homeless

Poor health is a major cause of being homeless. Conversely, being homeless is a contributing risk factor to developing poor health. Being homeless also makes it more difficult for people to access health care.

People without stable housing have higher rates of chronic and acute health conditions than those with housing.

73% of people who are homeless were found to have at least one unmet health care need. That includes 46% who have more than one medical condition, 48% who have a history of mental illness, and 41% in need of dental care.

There were 1.5 million people found to be homeless in 2014. Because of the Affordable Care Act, many more people who are homeless are eligible for Medical Assistance due to having limited or no income.

Enrolling in health insurance is one of the first steps for people who are homeless to access health care. With health insurance, people can receive continuous care for chronic health conditions. They can also access preventative care and disease management.

Consumer Health Coalition aims to provide outreach and assistance to people who are homeless so they can learn that free and low cost health insurance is available to them, enroll in coverage, and maintain their health coverage.

To do this, we partner with several organizations that provide outreach and assistance to people who are homeless. One partner organization is Operation Safety Net, where our Navigators attend various assistance sites including a mobile clinic that parks in high-need areas to serve the medical needs of people who are street homeless.

Veterans

Veterans often have physical and/or behavioral health needs relating to their service and the experience of readjusting to life after their service.

Some people assume that anyone who has served in the military can receive health coverage from the Veteran’s Administration (VA). While that is true for some, it is not true for everyone. There are several ways veterans can access health care, depending on their eligibility.

Some veterans have physical health care needs relating to their service. Many returning service members experience complex behavioral health disorders in the process of returning and readjusting to life after their service. Some mental health conditions veterans may experience include post traumatic stress disorder (PTSD), depression, anxiety, and increased risk of suicidal ideation.

It is essential for veterans to have comprehensive health care to meet their needs.

Veterans with VA benefits who have low incomes may be eligible to also enroll in Medical Assistance. This can provide coverage for non-VA visits and basic vision and dental care, which are not usually offered through the VA.

TRICARE is a health program for uniformed service members and their families, National Guard or Reserve members and their families, and some other related populations.

Veterans and/or their family members who are not enrolled with the VA or TRICARE can purchase private coverage on the Health Insurance Marketplace. For children, the Children’s Health Insurance Program (CHIP) is available

Both VA and TRICARE coverage are considered Minimal Essential Coverage under the Affordable Care Act. People enrolled in these coverage will not face a tax penalty and do not need to take extra steps to comply with the ACA.

Consumer Health Coalition is a member of PAServes, a resource service that connects former service members and their families with resources for many types of assistance. We also partner with veterans groups, like Veteran’s Place, to offer free enrollment assistance.

Contact our certified Navigators to learn about your Marketplace, Medicaid, or CHIP options. For those who have served in the military and have questions about VA or TRICARE eligibility, contact those programs directly.

People Living with HIV

People living with HIV face health disparities impacted by the social determinants of health, including racism, poverty, and stigma. This means that some population groups are at higher risk for infection with HIV, and those factors influence the risk.

HIV can be transmitted by sexual contact, contact with infected blood, or through breast milk. It cannot be transmitted through casual contact like hugging, shaking hands, or sharing restroom facilities.

HIV may not show any symptoms in its early stages, so it’s important to be tested (see below for resources). If left untreated, the virus continues to destroy cells that help the body fight infection. If too many immune cells are destroyed, the virus can progress to its final stage, which can be fatal.

To maintain health and reduce the risk of passing the virus to others, it’s important to take HIV medications, called antiretroviral therapy (ART). There is no cure for HIV at this time, although research continues. However, with advancements in medical technology, a person who is diagnosed and begins treatment before the virus reaches an advanced stage can live about as long as a person without HIV.

The final stage of HIV infection is progression to AIDS, acquired immunodeficiency syndrome. Many people living with HIV never reach this stage. At this stage, the virus has severely weakened the immune system. A person in this stage is at risk for developing opportunistic infections, often rare conditions that a strong immune system would have defeated on its own.

People living with HIV face health disparities impacted by the social determinants of health, including racism, poverty, and stigma. This means that some population groups are at higher risk for infection with HIV, and those factors influence the risk.

For example, studies have found that overall, black women face a higher risk of STD infection than white women with the same level of risk behaviors. Research attributes this difference to systemic racism in the U.S. Continuing inequity leads to black Americans facing higher rates of poverty, incarceration, and lack of access to medical care, all of which influence disproportionate risk for HIV infection.

Knowing your status is the first step to maintaining your health with HIV. It’s recommended that anyone who is sexually active or has used IV drugs be tested for HIV infection. Early diagnosis and treatment are key. Your primary care doctor may be able to provide testing. The Affordable Care Act lists HIV testing as a preventive care test that most insurers are required to cover without cost to you.